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Section 3
Secondary Consequences of Childhood Sexual Trauma:
Nightmares and Flashbacks

Question 3 | Test | Table of Contents

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In the last section, we discussed the secondary consequences of sexual abuse of the narrow range of emotions, emotional flooding, emotional numbing, and shortened attention span. These behaviors result when the pressure to release pain becomes stronger than the defenses being used.

In this section, we will look at the secondary consequences of feeling hopeless/helpless, nightmares and flashbacks. At the end, we will discuss two self-discovery exercises you might consider using with you clients.

According to the Incidence Study of Reported Child Abuse and Neglect, non-parental relatives represented the largest group of alleged perpetrators (44%), followed by biological fathers (8%), stepfathers (8%), other acquaintances (8%) and babysitters (7%). A child's friends (peers) and family friends were each identified as the alleged perpetrator in 5% of substantiated cases. Teachers were identified in 4% of cases, and other professionals, strangers and a parent's boyfriend/girl-friend were each identified in 2% of cases. In 5% of substantiated sexual abuse cases, mothers were identified as the alleged perpetrator (3% biological mothers and 2% step-mothers).

Kevin fell into the 44% who were perpetrated by non-parental relatives. In a case conference, a colleague of mine discussed Kevin, age 15, who felt he had no power to control what happened to him as a child.

Kevin remembers his uncle forcing him to have sex whenever he babysat. He struggled with the persistent feeling of hopelessness and helplessness. Kevin stated "There is this nagging feeling that anything I do won't turn out right --- you know, like what's the point?" Let's look at Kevin's nightmares and body memories.

Kevin suffered from violent nightmares that cause him to wake up screaming, sweating and in a state of terror or fear. In group, Kevin shared, "I keep having the same dream over and over. I'm in a house and there is a man trying to get in. I'm so afraid. I run from room to room, checking that all the windows and doors are closed and locked. My fear grows as I am sure he is going to get in, no matter what I do. I can't get to the last door. I see it begin to open and then I wake up screaming."

Regarding flashbacks Kevin stated, "I have thoughts of my uncle overpowering me. These pictures seem to happen more and more often. I can't believe this really happened to me. Am I crazy?" These extremely vivid and terrifying bits and pieces of memory surface without warning, leaving Kevin suddenly feeling out of control or "crazy". Kevin's therapist stated, "Flashbacks are mini scenarios, like a snap shot that is triggered by an object or person." Do you need to provide your Kevin with a definition of flashbacks in your next session?

As you know, while body memories are similar to flashbacks, they often surface during sex; are experienced by survivors of physical sexual abuse; and typically mirror the childhood sexual experience. Amber, age 19, experienced sexual abuse from her father between the ages of four to six. When Amber's mother discovered what was happening she divorced him.

Amber explained in group "Everything was normal. My boyfriend, Tony, and I were making love just as we always do. Then suddenly I felt smothered! I couldn't breathe! I panicked and I began to hit him. The pain was so powerful. It was horrible. I couldn't believe what was happening. Neither could Tony. We have made love lots of times before and nothing like this has ever happened." Amber did not realize she was sexually abused as a child, yet her body remembered in the middle of sex years later.

The following two self-discovery exercises helped Amber with her secondary consequences of nightmares, flashback, and body memories.

♦ "I Exercise" Technique
The first self-discovery exercise I call the "I Exercise," because the client completes the a statement that starts with the word "I." Because each of us rarely sees ourselves as being just one way, this exercise offers the opportunity to explore the many facets of self perception. I asked Amber to give me two answers to each of the following statements: I am…; I feel…; I think…; I do…: and I wish.

Like many clients, Amber gave negative responses to these questions. Amber stated, "I think I am a piece of garbage. I think no one likes me. I feel hopeless. I feel sick all the time. I am never going to get better. I am a bad girl. I do need to work on myself. I do not like myself. I wish I was done with this. I wish I was dead.

♦ Feeling Responses Technique
I also found the Feeling Responses exercise to be helpful with Amber by identifying the situations or experiences that produced her particular state of fear, joy, anger, etc… I requested Amber respond to the following phrases. I repeated each phrase several times: I feel most afraid when…..; I feel the most joy when ….. ; I feel angriest when… ; I feel saddest when…; I feel the most hurt when…; I feel the most ashamed when…; and I feel the most stressed out when….

Amber's Feeling Responses:
1. I feel most afraid when I think about what my Father did.
2. I feel the most joy when I think about the fact that my mother divorced my father for it.
3. I feel angriest when about how my father took advantage of me.
4. I feel saddest when I think about how this affects me now.
5. I feel the most hurt when I feel my father didn't love me enough to stop.
6. I feel the most ashamed when part of me enjoyed it and...
7. I feel the most stressed out when I think about having sex and the pain returning.

As you can see, the use of incomplete phrases helped Amber to explore her feelings to enable her to release them by moving the feelings from her unconscious to her conscious awareness.

How about your Amber or perhaps a Kevin you are treating would they benefit from identifying and expressing feelings by completing "I" phrases or "feeling" phrases?

The use of "I" phrases and "feeling" phrase exercises I find most probably are not completed in one sitting, but provide a variety of thought provoking questions to stimulate the self-discovery process, bring the unconscious to the conscious, and facilitate the healing process.

Now that we have talked about the secondary consequences of feeling hopeless and helpless, nightmares and flashbacks and in the previous section the narrow range of emotions, emotional flooding, emotional numbing and shortened attention span. The next section will discuss the secondary consequences of panic attacks, body objectification, chronic fatigue and minor illnesses. You will receive the technique of view from the eyes of others exercise.
Reviewed 2023

Peer-Reviewed Journal Article References:
Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(5), 965–971.

Cuddy, M. A., & Belicki, K. (1992). Nightmare frequency and related sleep disturbance as indicators of a history of sexual abuse. Dreaming, 2(1), 15–22.

Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124. 

Ferrajão, P. C., & Elklit, A. (2020). World assumptions and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse: A longitudinal study. Psychology of Violence, 10(5), 501–508. 

Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507.

Priebe, K., Kleindienst, N., Zimmer, J., Koudela, S., Ebner-Priemer, U., & Bohus, M. (2013). Frequency of intrusions and flashbacks in patients with posttraumatic stress disorder related to childhood sexual abuse: An electronic diary study. Psychological Assessment, 25(4), 1370–1376.

QUESTION 3
What experiences similar to a flashback, often surface during sex and are experienced by survivors of physical sexual abuse? To select and enter your answer go to Test.

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